The URL can be used to link to this page

Home My WebLink AboutPermit Mechanical 1995-2-23 . .. SPRINGFIELD , YOOD STOVE/INSERT INSPECTION APPLICATION CITY OF SPRINGFEILD BUILDING SAFETY DIVISION 225 Fifth Street Springfield, Oregon 97477 Office: INSPECTION LINE: 726-3759 726-376lr"', . \ \ \4 f~\ 1\f\l\ \-\- '''"''''' M.p" 1'll'i3a.it1 - Ovner: fL~ lV"0\\O~ (\ Q K$\ f\ Address: -\$~G C~\\\{\~ G:t",,\\\ Phone: #: ~t ~<f\1 - City:,,~}J..,f\[J8Q~.r}t State: \\A~t\fIn Zip Code: Ch4lff> Value of -yld Stov:)~~~let Stove/Insert:~. ~ ()n,CD ~ ...J Preliminary Inspection is $15.00 (prior to installation of insert) Yood Stove/Pellet/Insert Permit is $15.00 + $.75 state surcharge + $.45 administrative fee + $10.00 issuance = $26.20~otal - \'\ ~ ~~ Type of Ins l ction Req~ed~ J{\O \ tm4 I. _ \{ ~ \~ 9.L -..Jt \~ rt Contractor!= if-.n ~Q n ~ - Phone #: Ck-\CQ,\O\~ _ ~"5\"L~_)'[C\State:_~ Zip Code: CfAA-l,f) Construction Contractors Registhtion #: LiqJQ.L Expires: ,I),. \, ~ By signing this permit/application, I ~l for inspection(s) as required (726-3769), I state that all the information on this permit/application is correct and that I vas provided with the Yood Stove Safety information for wood burning appliances and preliminary inspection standards. I further state that the appliance I am installing meets smoke emission standards as set by the Oregon Department of Environmental Quali ty or the Federal Environmental Protection Agency and I agree to provide the testing approval number to the inspector at the time of inspection. I also understand that if I am requesting a preliminary inspection, the wall covering may be required to be removed. Tax Lot #: ffifJO( ) Job Loca t ion: \ ff q!:II ~ ~ ~-<"___ -;:- J. j. 3 /7 f,)- d;0ture (/ Date ======================================================================================= FOR OFFICE USE ./ REQUIRED INSPECTION(S): \I00DSTOGI~J PRELIMINARY L/' Date of Application: r!)./J.1. ).QS ../ Job #: q~~,{)?_~~ ",.1'''''' eon.md,'\-\1D. J , ,,~ - ) Receipt #: (\O()~lt; Issued By: (_J'j\L-J~ Checked for Deliquencies: Checked for Historical Status: -- "- . . Permi1 #: q DOL.~ Address: \ l \4. (\J () ; f\ (\. ~-t) Issued by: "rI\ U)Cl ') Date: r9 /] ~ g~ Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law, ORS 701,055(4), requires residential construction permit appli- cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued, This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from registration under ORS 701,010(7), need not submit this statement, This statement will be filed with the permit, Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~ I, I own, reside in, or will reside in the completed structure, m 2, I understand that I mus1 register as a cDnstruction contrac1or if the structure is sold or offered for sale before or upon comPIetioJ;\~ 4 r 3A, My general contrac1or ifiM Qi.F/flll.J1 .' 7 2-.12. $ L , (Nam ) Contractor regis. # I will instruct my general contrac1or that all subcontrac1ors who work on the slructure must be registered with the Construction contrac1ors Board, OR D 3B, I will be my own general contractor, If I hire subcontractors, I will hire only subcontractors registered with the Construction contrac1ors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CcB and will immedia1ely notify 1he office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. X Pi;oiLl II. rf::.__.. () . (SigM{';ure of permit applicant) ;::; jJ ,t::r (Date) /99 < -- (White copy to issuing agency permit file. pink copy to applicant) . . - . - Ii RITil1ci"maJftioi1 Mciice ~o Pi'Opeuiy OWl1'!ei's A~Oi!.llft CiO~S~i'.IUI,CftiiOlTil fRes~ol/'lsii)iiifties J , ~ ~. . . " Note:' This Infonnation !yoti(;e to Property Owners about Construction Responsibilities ;' ~ . , ' . was developed by the Construction Contractors Board in accordance with ORS 701.055(5), If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern, EMPLOYER RESPONSIBILITIES: If you hire persons ,not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees, As the employer, you must comply with the following: Oregon's withholding tax law: As an employer, you must withhold income taxes from employec wages at the time employees are paid, You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Oregon Dept. of Revenue at 945-8091. Unemployment insurance lax: As an employer. you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources at 378-3524, Workers' compensation insurance: As an employer. you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees, If you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job. For more information, call the Workers' Compensation Division at the Department of Consumer and Busfness Services at 945-7888, , , , U.S. Internal Revenue Service: As 1m employer, you must withhold federal income tax from employees' wages, You will be liable for the tax payment even if you didn't actually withhold the tax, For more information, call the Internal Revenue Service at 1-800-829-1040, OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requiremcnts that may bc brought to your attention through inspections. Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done, Time to supernse employees: Make sure you have sufficient time to supervise your employees, Expertise: Make sure you have the expertise to act as your own general contractor. to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections, , If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem. OR 97309-5052. 503/378-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem, prop.-own.pm4 1/94